【作者】 韩慧；

【导师】 叶冬青；

【作者基本信息】 安徽医科大学 ， 流行病与卫生统计学， 2008， 硕士

【摘要】 目的了解系统性红斑狼疮(SLE)的流行病学、临床表现、常规实验室检查的特点及用药情况,评估常规实验室检查指标在SLE的诊断、判断病情活动程度中的意义,同时探讨各因素对首发症状的影响及使用激素治疗的影响。以便从中吸取经验教训,找出其临床共性与特性,利于早诊断、早治疗、提高疗效、延长患者生存期和提高患者生活质量。方法对1997年1月～2007年12月间在蚌埠医学院附属医院住院的572例SLE患者的临床资料进行回顾性研究,了解患者的一般情况、职业、首发症状、临床表现、实验室检查指标、家族史和预后等,对患者的病情进行计分和分类,利用统计学方法得出相关结论。结果1、一般情况: 572例患者中,男32例,女540例,男女比例为1:16.88,城市患者153例,农村及城郊患者419例,城乡比例为1:2.7。年龄最小7岁,最大者80岁,平均年龄33.55岁。平均发病年龄18.67岁。病程最短0月,最长144月,平均病程20.37月。平均住院时间为16.50天。所有统计病例中活动期患者463例,稳定期患者109例;首次发病患者215例,再发患者357例。2、临床表现:在首发症状中,关节痛是最常见的,占58.6%,其次分别是皮疹、红斑36.7%、发热34.8%、其它21.3%、浮肿8.4%、肌肉酸痛,腰背痛6.6%。重要脏器损害包括:泌尿系统受累最多42.1%,以狼疮肾炎37.9%为主,其次为尿路感染5.6%,再次为慢性肾衰竭2.3%;呼吸系统受累占21.2%,包括肺部感染占9.8%,上呼吸道感染占7.7% ;血液系统受累占19.8%,包括败血症5.1%,高血压3.3%;免疫系统受累占7.9%,包括干燥综合症4.2%,糖尿病1.2%;消化系统受累占7.3%,包括肝功能损伤2.4%,肝炎和胆囊炎分别为1.2%;神经系统受累占7.2%,包括狼疮脑病3.7%,神经精神狼疮2.3%;运动系统和生殖系统受累较少,分别为5.1%,0.3%,其他10.3%。3、常规实验室检查:3.1 572例患者中血液系统异常113例(19.76%),血小板减少发生率按病情活动来分析,其水平轻度活动组比基本无活动组和中度活动组高(P<0.05)。各组间白细胞的减少发生率差异无显著性(P>0.05)。3.2尿常规中尿蛋白和尿潜血阳性率分别为50.7%,26.2%,而24小时尿蛋白异常率为89.5%。(57人做了此检查,51人异常)3.3 ESR和CRP升高发生率分别为73.1%,55.1%;在各病情活动组间ESR差异有显著性(P<0.05),而各组间ESR水平差异也有显著性(P<0.05),其水平随病情活动度增加而有升高的趋势。3.4抗ds-DNA,抗Sm阳性率分别为56.0%,56.4%,C3降低、C4降低的发生率分别是36.6%,18.7%。其中在各病情活动组间抗ds-DNA阳性率和C3降低差异有显著性(P<0.05)。4、治疗根据572例患者的用药情况发现,激素使用率高达97.0%,其次是抗感染药,所占比例为49.1%,非甾体类抗炎药物、环磷酰胺、抗疟药及雷公藤所占比例分别为20.3%,12.6%,9.4%和7.9%。结论1、育龄妇女是SLE多发群体。2、关节炎或关节痛是SLE患者最主要的首发症状,可作为SLE重要临床特征之一。3、重要脏器损害以肾脏受累最多,多数为狼疮肾炎,其次为呼吸系统和血液系统,而神经系统和运动,生殖系统受累较少。4、白细胞水平与SLE病情活动度未见明显关联,SLE既可出现白细胞下降,也可出现白细胞升高。5、CRP升高发生率、C4降低发生率及抗Sm阳性率与SLE病情活动度未见明显关联。6、ESR升高发生率、C3降低的发生率及抗ds-DNA阳性率与SLE病情活动度有明显关联,其中ESR水平也与SLE病情活动度有明显关联,可以作为判断SLE病情活动度的参考指标。7、在住院病人的治疗用药中发现,激素的使用率高达97.0%,其次是抗感染药,所占比例为49.1%,提示激素迄今仍是治疗SLE的主要药物,但要恰当使用,否则会增加患者发生感染的概率。更多还原

【Abstract】 Objective To summarize the characteristics of Epidemiology,clinical manifestation and regular laboratory examination and medication situation.And to assess the utility of measurement of laboratory parameters in the diagnosis,evaluating the disease activity and exploring the influence of hormonal therapy.Then to draw experiences and lessons from the summary of SLE,seek the clinical commonness and characteristics of SLE beneficial to the earlier diagnosis and therapy,raise curative effect, prolong the survival period and improve the life quality of the patients.Methods Retrospective epidemiological survey was used on 572 hospitalized SLE patients in the affiliated hospital of Bengbu Medical College from January 1997 to December 2007. Their general condition ,career, the first symptom,clinical manifestation, index of laboratory examination, family history ,prognosis and the degree of disease activity were collected and then made a related conclusion by statistical analysis.Results1. Demographic details: The study cohort comprised 540 female and 32 male patienis,the ratio of women to men was l:16.88.The number of city patients was 153,and the number of countryside patients was 419,the city and countryside proportion is 1:2.7.The average age was 33.55 years.The average age of the onset of the disease was 18.67,a mean follow-up of 20.37 months.The mean duration in hospital was 16.50 days.The number of the patients with active-stage was 463,the number of the patients with inactive-stage was 100.The number of the patients of first morbidity was 215 and the number of the patients of once more morbidity was 357.2. Clinical features: The onset maniefstation was arthritic ache,its frequence was 58.6%.The cumulative frequeneies of organic involvement were: urinary system 42.1% was in the first place,respiratory system 21.2%,haematological 19.8%,digesting system 7.3% and neurological 7.2%.3. Laboratory data:3.1 The frequence of hematological exceptionally was 19.76%. The PLT of different case groups showed significant difference in its incidence rate of decrease, its formation rate in the slightly active group was higher than the basically inactive group and medially active group(P<0.05). The WBC of different case groups showed no obvious difference in its incidence rate of decrease.3.2 The positive rates of the Urine protein and Urine occult blood(OB)in the urine RT respectively were 50.7%,26.2%.Abnormity rate of the 24 hours Urine protein(24hUPr) was 89.5%.3.2 The increase incidence rates of the ESR and CRP respectively were 73.1%,26.2%;it was showed obvious difference in the increase incidence rate of the ESR was shown in different groups (P<0.05),and the ESR level in different groups was significant different (P<0.05),too, its level increased with the degree of the disease activity.3.4 The positive rate of the anti-dsDNA and anti-Sm respectively were 56.0%, 56.4%,;The incidence rate of the C3 decrease and C4 decrease respectively were 36.6%, 18.7%. The C3 in its decrease incidence rate and anti-dsDNA in its positive rate in different groups were significantly different(P<0.05).4. Treatment: Hormone is the best curative thearpy strategis: The total number of the patients with hormone was 554,its percentage was 97.0%.Conclusion1. The male/female ratio in the hospital and patients age accords with disease disciplinarian.2. The main initial symptoms were arthrodynia and arthritis.They can be used as the significant clinical characteristics.3. The most important organ damage is kidney,Next came respiratory system and hematological system.4. There were no statistically significant difference in the correlation of the level of leucocyte and the activity degree of SLE.5. The incidence of the CRP increase, the incidence of the C4 decrease and the positive rate of the anti-Sm have no obvious correlation with the disease activity degree of SLE.6. It was showed obvious difference in the incidence of the ESR increase, the incidence of the C3 decrease and the positive rate of the anti-dsDNA was shown in different groups (P<0.05),and the ESR level in different groups was significant different (P<0.05),too.So the ESR level may be an index in the judgement of the disease activity in SLE.7. The main drugs for treatment still was hormone, its usage rate was 97.0%. Hormone should be used properly to prevent the infection of the patients.更多还原